{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T19:42:20Z","timestamp":1785613340428,"version":"3.56.0"},"reference-count":97,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Vulvar and perineal reconstruction represents a significant surgical challenge, particularly in the context of oncological resections, trauma, or postpartum injuries. Vulvar cancer, predominantly squamous cell carcinoma, often necessitates extensive resections, leading to significant tissue defects and high rates of postoperative complications. Reconstructive procedures, encompassing skin grafts and local, regional, and distant flaps, are intended to restore the anatomical structure, protect internal organs, and enhance functional outcomes and quality of life. The selection of technique is contingent upon the dimensions of the defect, its location, the patient\u2019s condition, and the availability of suitable tissue. The management of minor defects can be accomplished through local advancements, while more extensive or complex cases necessitate the utilization of musculocutaneous (e.g., VRAM) or fasciocutaneous (e.g., ALT) flaps. The present article provides a review of surgical methods of vulvar and perineal reconstruction, with a focus on indications, techniques, and potential complications.<\/jats:p>","DOI":"10.3390\/jcm14134456","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T07:42:34Z","timestamp":1750664554000},"page":"4456","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Reconstruction of the Vulva and Perineum\u2014Comparison of Surgical Methods"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3739-2066","authenticated-orcid":false,"given":"Anna","family":"J\u0119drasiak","sequence":"first","affiliation":[{"name":"Department of Reconstructive Surgery and Gynecological Oncology, Pomeranian Medical University in Szczecin, Al. Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honorata","family":"Juniewicz","sequence":"additional","affiliation":[{"name":"Department of Reconstructive Surgery and Gynecological Oncology, Pomeranian Medical University in Szczecin, Al. Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiktoria","family":"Raczek","sequence":"additional","affiliation":[{"name":"Department of Reconstructive Surgery and Gynecological Oncology, Pomeranian Medical University in Szczecin, Al. Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicja","family":"Srokowska","sequence":"additional","affiliation":[{"name":"Department of Reconstructive Surgery and Gynecological Oncology, Pomeranian Medical University in Szczecin, Al. Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-2153","authenticated-orcid":false,"given":"Mateusz","family":"Koz\u0142owski","sequence":"additional","affiliation":[{"name":"Department of Reconstructive Surgery and Gynecological Oncology, Pomeranian Medical University in Szczecin, Al. Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aneta","family":"Cymbaluk-P\u0142oska","sequence":"additional","affiliation":[{"name":"Department of Reconstructive Surgery and Gynecological Oncology, Pomeranian Medical University in Szczecin, Al. Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.2478\/raon-2020-0053","article-title":"Modern treatment of vulvar cancer","volume":"54","author":"Merlo","year":"2020","journal-title":"Radiol. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2174","DOI":"10.1002\/ijc.30900","article-title":"Vulvar cancer in high-income countries: Increasing burden of disease","volume":"141","author":"Kang","year":"2017","journal-title":"Int. J. Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/ijc.33198","article-title":"Vulvar intraepithelial neoplasia: Incidence and long-term risk of vulvar squamous cell carcinoma","volume":"148","author":"Thuijs","year":"2021","journal-title":"Int. J. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.ygyno.2017.10.029","article-title":"Vulvar intraepithelial neoplasia: Risk factors for recurrence","volume":"148","author":"Satmary","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1097\/PGP.0000000000000280","article-title":"The Natural History of Vulvar Intraepithelial Neoplasia, Differentiated Type: Evidence for Progression and Diagnostic Challenges","volume":"35","author":"Bigby","year":"2016","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1111\/aogs.14814","article-title":"Differentiated vulvar intraepithelial neoplasia long-term follow up and prognostic factors: An analysis of a large historical cohort","volume":"103","author":"Gallio","year":"2024","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1055\/s-0042-1756294","article-title":"Vulvar Reconstruction Using Keystone Flaps Based on the Perforators of Three Arteries","volume":"49","author":"Lee","year":"2022","journal-title":"Arch. Plast. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1136\/ijgc-2023-004486","article-title":"European Society of Gynaecological Oncology Guidelines for the Management of Patients with Vulvar Cancer-Update 2023","volume":"33","author":"Oonk","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Restaino, S., Pellecchia, G., Arcieri, M., Bogani, G., Taliento, C., Greco, P., Driul, L., Chiantera, V., De Vincenzo, R.P., and Garganese, G. (2025). Management of Patients with Vulvar Cancers: A Systematic Comparison of International Guidelines (NCCN-ASCO-ESGO-BGCS-IGCS-FIGO-French Guidelines-RCOG). Cancers, 17.","DOI":"10.3390\/cancers17020186"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Caretto, A.A., Servillo, M., Tagliaferri, L., Lancellotta, V., Fragomeni, S.M., Garganese, G., Scambia, G., and Gentileschi, S. (2023). Secondary post-oncologic vulvar reconstruction\u2014A simplified algorithm. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1195580"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1111\/IGC.0b013e3181d92723","article-title":"Period prevalence and risk factors for postoperative short-term wound complications in vulvar cancer: A cross-sectional study","volume":"20","author":"Senn","year":"2010","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.ygyno.2016.11.009","article-title":"Patient, treatment and discharge factors associated with hospital readmission within 30days after surgery for vulvar cancer","volume":"144","author":"Dorney","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_13","unstructured":"Raposio, E., Moioli, M., Raposio, G., Spinaci, S., and Cagnacci, A. (2022). Perforator flaps for vulvar reconstruction: Basic principles. Acta Biomed., 93."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"379","DOI":"10.5999\/aps.2014.41.4.379","article-title":"Subunit principle of vulvar reconstruction: Algorithm and outcomes","volume":"41","author":"Tan","year":"2014","journal-title":"Arch. Plast. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e60","DOI":"10.3802\/jgo.2016.27.e60","article-title":"Surgical therapy of vulvar cancer: How to choose the correct reconstruction?","volume":"27","author":"Gentileschi","year":"2016","journal-title":"J. Gynecol. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1177\/145749691310200107","article-title":"Reconstruction of the vulva with sensate gluteal fold flaps","volume":"102","author":"Kuokkanen","year":"2013","journal-title":"Scand. J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.bjps.2013.02.010","article-title":"The gluteal fold flap: A versatile option for perineal reconstruction following anorectal cancer resection","volume":"66","author":"Pantelides","year":"2013","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jpra.2018.10.006","article-title":"Gluteal fold flap for pelvic and perineal reconstruction following total pelvic exenteration","volume":"19","author":"Ishikawa","year":"2019","journal-title":"JPRAS Open."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1097\/00006534-200112000-00025","article-title":"The gluteal-fold flap for vulvar and buttock reconstruction: Anatomic study and adjustment of flap volume","volume":"108","author":"Hashimoto","year":"2001","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e3550","DOI":"10.1097\/GOX.0000000000003550","article-title":"Secondary Vulvar Reconstruction Using Bilateral Gluteal Fold Flaps after Radical Vulvectomy with Direct Closure","volume":"9","author":"Roh","year":"2021","journal-title":"Plast. Reconstr. Surg. Glob. Open."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.anplas.2018.03.007","article-title":"Triple flap technique for vulvar reconstruction","volume":"63","author":"Mercut","year":"2018","journal-title":"Ann. Chir. Plast. Esthet."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"461","DOI":"10.5999\/aps.2016.43.5.461","article-title":"Three-Directional Reconstruction of a Massive Perineal Defect after Wide Local Excision of Extramammary Paget\u2019s Disease","volume":"43","author":"Cho","year":"2016","journal-title":"Arch. Plast. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/0022-3468(92)90310-4","article-title":"Anterior perineal approach and three-flap anoplasty for imperforate anus: Optimal reconstruction with minimal destruction","volume":"27","author":"Yazbeck","year":"1992","journal-title":"J. Pediatr. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0020-7292(99)00016-8","article-title":"V\u2014Y flap for perineal reconstruction following modified approach to vulvectomy in vulvar cancer","volume":"65","author":"Carramaschi","year":"1999","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.ejogrb.2012.05.035","article-title":"A modified triple incision technique for women with locally advanced vulvar cancer: A description of the technique and outcomes","volume":"164","author":"Li","year":"2012","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.suronc.2017.10.002","article-title":"Vulvo-vaginal reconstruction after radical excision for treatment of vulvar cancer: Evaluation of feasibility and morbidity of different surgical techniques","volume":"26","author":"Bracchi","year":"2017","journal-title":"Surg. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1097\/IGC.0000000000000765","article-title":"Modified Gluteal Fold V-Y Advancement Flap for Reconstruction After Radical Vulvectomy","volume":"26","author":"Conri","year":"2016","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_28","first-page":"129","article-title":"Medical and surgical management of perianal Crohn\u2019s disease","volume":"31","author":"Adegbola","year":"2018","journal-title":"Ann. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.gore.2018.08.007","article-title":"Utilizing V-Y fasciocutaneous advancement flaps for vulvar reconstruction","volume":"26","author":"Hand","year":"2018","journal-title":"Gynecol. Oncol. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.ygyno.2013.10.037","article-title":"Modified gluteal fold advancement V-Y flap for vulvar reconstruction after surgery for vulvar malignancies","volume":"132","author":"Bracchi","year":"2014","journal-title":"Gynecol. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/iwj.12997","article-title":"Experience with gluteal V-Y fasciocutaneous advancement flaps in vulvar reconstruction after oncological resection and a modification to the marking: Playing with tension lines","volume":"16","author":"Fin","year":"2019","journal-title":"Int. Wound J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"100505","DOI":"10.1016\/j.gore.2019.100505","article-title":"New Keystone flap application in vulvo-perineal reconstructive surgery: A case series","volume":"30","author":"Peiretti","year":"2019","journal-title":"Gynecol. Oncol. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/j.1445-2197.2012.06021.x","article-title":"\u2018Perineal keystone design perforator island flap\u2019 for perineal and vulval reconstruction","volume":"82","author":"Behan","year":"2012","journal-title":"ANZ J. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"95","DOI":"10.4103\/nmj.NMJ_30_19","article-title":"Keystone Flaps in Urethroplasty: Reconstruction in a Complex Case of Panurethral Stricture Disease","volume":"60","author":"Kalra","year":"2019","journal-title":"Niger. Med. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1002\/micr.20663","article-title":"Perineal and posterior vaginal wall reconstruction with superior and inferior gluteal artery perforator flaps","volume":"29","author":"Wagstaff","year":"2009","journal-title":"Microsurgery"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e6581","DOI":"10.1097\/GOX.0000000000006581","article-title":"Vulvovaginal Reconstruction With a Modified Pedicled Anterolateral Thigh Flap","volume":"13","author":"Kondo","year":"2025","journal-title":"Plast. Reconstr. Surg. Glob. Open."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1002\/jso.27092","article-title":"Impact of etiology leading to abdominoperineal resection with anterolateral thigh flap reconstruction: A retrospective cohort study","volume":"127","author":"Meuli","year":"2023","journal-title":"J. Surg. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e2733","DOI":"10.1097\/GOX.0000000000002733","article-title":"Pelvic\/Perineal Reconstruction: Time to Consider the Anterolateral Thigh Flap as a First-line Option?","volume":"8","author":"Perrault","year":"2020","journal-title":"Plast. Reconstr. Surg. Glob. Open."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/00006534-200001000-00029","article-title":"Anterolateral thigh fasciocutaneous flap in the difficult perineogenital reconstruction","volume":"105","author":"Luo","year":"2000","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1007\/s00064-022-00772-9","article-title":"Pedicled anterolateral thigh flap reconstruction in the region of the lower abdomen, groin, perineum, and hip","volume":"34","author":"Jakubietz","year":"2022","journal-title":"Oper. Orthop. Traumatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1097\/PRS.0b013e31820e9223","article-title":"Anterolateral thigh flap-based reconstruction for oncologic vulvar defects","volume":"127","author":"Zeng","year":"2011","journal-title":"Plast Reconstr. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.jamcollsurg.2007.12.007","article-title":"Outcomes of immediate vertical rectus abdominis myocutaneous flap reconstruction for irradiated abdominoperineal resection defects","volume":"206","author":"Butler","year":"2008","journal-title":"J. Am. Coll. Surg."},{"key":"ref_43","first-page":"ic2","article-title":"The Vertical Rectus Abdominis Musculocutaneous Flap As a Versatile and Viable Option for Perineal Reconstruction","volume":"17","author":"Coombs","year":"2017","journal-title":"Eplasty"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.bjps.2020.10.100","article-title":"Vertical rectus abdominis flap (VRAM) for perineal reconstruction following pelvic surgery: A systematic review","volume":"74","author":"Radwan","year":"2021","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Eseme, E.A., Scampa, M., Viscardi, J.A., Ebai, M., Kalbermatten, D.F., and Oranges, C.M. (2022). Surgical Outcomes of VRAM vs. Gracilis Flaps in Vulvo-Perineal Reconstruction Following Oncologic Resection: A Proportional Meta-Analysis. Cancers, 14.","DOI":"10.3390\/cancers14174300"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/DCR.0b013e31827a267c","article-title":"Dynamic article: Vaginal and perineal reconstruction using rectus abdominis myocutaneous flap in surgery for locally advanced rectum carcinoma and locally recurrent rectum carcinoma","volume":"56","author":"Holman","year":"2013","journal-title":"Dis. Colon Rectum."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e254773","DOI":"10.1136\/bcr-2023-254773","article-title":"Vulvar reconstruction in post-RT case using the versatile VRAM flap: Reporting the rare extrapelvic approach","volume":"16","author":"Baruah","year":"2023","journal-title":"BMJ Case Rep."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Faur, I.F., Clim, A., Dobrescu, A., Prodan, C., Hajjar, R., Pasca, P., Capitanio, M., Tarta, C., Isaic, A., and Noditi, G. (2023). VRAM Flap for Pelvic Floor Reconstruction after Pelvic Exenteration and Abdominoperineal Excision. J. Pers. Med., 13.","DOI":"10.20944\/preprints202311.1995.v1"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/00006250-197907000-00022","article-title":"Gracilis myocutaneous flap in reconstruction of the vulva and female perineum","volume":"54","author":"Wheeless","year":"1979","journal-title":"Obstet. Gynecol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1097\/PRS.0000000000011315","article-title":"Interposing Rectus and Gracilis Muscle Flaps for Pelvic Reconstruction in Bladder Exstrophy after Bladder Neck Closure","volume":"154","author":"Harris","year":"2024","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"107278","DOI":"10.1016\/j.ejso.2023.107278","article-title":"Primary flap closure of perineal defects to avoid empty pelvis syndrome after pelvic exenteration in gynecologic malignancies: An old question to explore a new answer","volume":"50","author":"Arcieri","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/SAP.0b013e3182414485","article-title":"An algorithmic approach to perineal reconstruction after cancer resection--experience from two international centers","volume":"71","author":"John","year":"2013","journal-title":"Ann. Plast. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.bjps.2008.11.067","article-title":"Gracilis muscle interposition for the treatment of recto-urethral and rectovaginal fistulas: A retrospective analysis of 35 cases","volume":"62","author":"Ulrich","year":"2009","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.bjps.2018.12.044","article-title":"Surgical outcomes of VRAM versus gracilis flaps for the reconstruction of pelvic defects following oncologic resection","volume":"72","author":"Stein","year":"2019","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ygyno.2015.01.526","article-title":"Pedicle perforator flaps for vulvar reconstruction--new generation of less invasive vulvar reconstruction with favorable results","volume":"137","author":"Huang","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Tsoi, L.C., Iyer, M.K., Stuart, P.E., Swindell, W.R., Gudjonsson, J.E., Tejasvi, T., Sarkar, M.K., Li, B., Ding, J., and Voorhees, J.J. (2015). Analysis of long non-coding RNAs highlights tissue-specific expression patterns and epigenetic profiles in normal and psoriatic skin. Genome Biol., 16.","DOI":"10.1186\/s13059-014-0570-4"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/SAP.0000000000002986","article-title":"Perineal Reconstruction with the Profunda Artery Perforator Flap","volume":"88","author":"Arquette","year":"2022","journal-title":"Ann. Plast. Surg."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1080\/23320885.2019.1583568","article-title":"Reconstruction of critically-sized perineal defect with perforator flap puzzle technique: A case report","volume":"6","author":"Kosutic","year":"2019","journal-title":"Case Rep. Plast. Surg. Hand. Surg."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2654","DOI":"10.1016\/j.bjps.2021.03.038","article-title":"The combined use of pedicled profunda artery perforator and bilateral gracilis flaps for pelvic reconstruction: A cohort study","volume":"74","author":"Sharp","year":"2021","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.gore.2019.06.004","article-title":"Recurrence of vulvar carcinoma: A multidisciplinary approach","volume":"29","author":"Rei","year":"2019","journal-title":"Gynecol. Oncol. Rep."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.ygyno.2015.06.031","article-title":"Vaginal reconstruction with pedicled vertical deep inferior epigastric perforator flap (diep) after pelvic exenteration. A consecutive case series","volume":"138","author":"Ferron","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1016\/j.bjps.2011.04.013","article-title":"Pedicled thinned deep inferior epigastric artery perforator flap for perineal reconstruction: A preliminary report","volume":"64","author":"Fang","year":"2011","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.bjps.2023.07.005","article-title":"Outcomes of DIEP flap reconstruction after pelvic cancer surgery: A retrospective multicenter case series","volume":"85","author":"Pividori","year":"2023","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1055\/s-0032-1333322","article-title":"Split and thinned pedicle deep inferior epigastric perforator (DIEP) flap for vulvar reconstruction","volume":"29","author":"Cheng","year":"2013","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.jpra.2024.05.005","article-title":"Advancing indocyanine green fluorescence flap perfusion assessment via near infrared signal quantification","volume":"41","author":"Dalli","year":"2024","journal-title":"JPRAS Open"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1016\/j.fertnstert.2019.08.063","article-title":"Real-time indocyanine green fluorescent angiography in laparoscopic sigmoid vaginoplasty to assess perfusion of the pedicled sigmoid segment","volume":"112","author":"Bouman","year":"2019","journal-title":"Fertil. Steril."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Lobbes, L.A., Hoveling, R.J.M., Schmidt, L.R., Berns, S., and Weixler, B. (2022). Objective Perfusion Assessment in Gracilis Muscle Interposition-A Novel Software-Based Approach to Indocyanine Green Derived Near-Infrared Fluorescence in Reconstructive Surgery. Life, 12.","DOI":"10.3390\/life12020278"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1055\/s-0039-1700548","article-title":"Preliminary Use of Indocyanine Green Fluorescence Angiography and Value in Predicting the Vascular Supply of Tissues Needed to Perform Cloacal, Anorectal Malformation, and Hirschsprung Reconstructions","volume":"30","author":"Rentea","year":"2020","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Capozzi, V.A., Monfardini, L., Sozzi, G., Armano, G., Rosati, A., Gueli Alletti, S., Cosentino, F., Ercoli, A., Cianci, S., and Berretta, R. (2021). Subcutaneous Vulvar Flap Viability Evaluation With Near-Infrared Probe and Indocyanine Green for Vulvar Cancer Reconstructive Surgery: A Feasible Technique. Front. Surg., 8.","DOI":"10.3389\/fsurg.2021.721770"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1055\/s-0043-1771236","article-title":"Robotic Rectus Abdominis Harvest for Pelvic Reconstruction after Abdominoperineal Resection","volume":"37","author":"Appel","year":"2023","journal-title":"Semin. Plast. Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.bjps.2024.02.031","article-title":"Robotic harvest of the free gracilis muscle flap","volume":"90","author":"Sert","year":"2024","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"3738","DOI":"10.1245\/s10434-015-4435-1","article-title":"Reconstruction of Large Perineal and Pelvic Wounds Using Gracilis Muscle Flaps","volume":"22","author":"Chong","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1097\/PRS.0000000000009233","article-title":"Reducing Complications and Expanding Use of Robotic Rectus Abdominis Muscle Harvest for Pelvic Reconstruction","volume":"150","author":"Davila","year":"2022","journal-title":"Plast Reconstr Surg."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1097\/PRS.0000000000008592","article-title":"Robotic Rectus Abdominis Muscle Flap following Robotic Extirpative Surgery","volume":"148","author":"Asaad","year":"2021","journal-title":"Plast Reconstr Surg."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1055\/s-2008-1055325","article-title":"Perineal wound complications after abdominoperineal resection","volume":"21","author":"Wiatrek","year":"2008","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/WON.0000000000000057","article-title":"Smoking, chronic wound healing, and implications for evidence-based practice","volume":"41","author":"McDaniel","year":"2014","journal-title":"J. Wound Ostomy Cont. Nurs."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1080\/00016340601089875","article-title":"Lower uterine blood supply: Extrauterine anastomotic system and its application in surgical devascularization techniques","volume":"86","author":"Barbosa","year":"2007","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"314","DOI":"10.11604\/pamj.2019.33.314.19488","article-title":"Non-obstetric vulva haematomas in a low resource setting: Two case reports","volume":"33","author":"Mangwi","year":"2019","journal-title":"Pan Afr. Med. J."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1097\/01.prs.0000227683.47836.28","article-title":"Gluteal fold V-Y advancement flap for vulvar and vaginal reconstruction: A new flap","volume":"118","author":"Lee","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1007\/s00404-010-1603-1","article-title":"Vulvar reconstruction using a \u201cV-Y\u201d fascio-cutaneous gluteal flap: A valid reconstructive alternative in post-oncological loss of substance","volume":"282","author":"Lazzaro","year":"2010","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"e5965","DOI":"10.1097\/GOX.0000000000005965","article-title":"Vulvar Reconstruction with Keystone Flaps after Radical Vulvectomy","volume":"12","year":"2024","journal-title":"Plast. Reconstr. Surg. Glob. Open."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1046\/j.1445-2197.2003.02638.x","article-title":"The Keystone Design Perforator Island Flap in reconstructive surgery","volume":"73","author":"Behan","year":"2003","journal-title":"ANZ J. Surg."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/SAP.0000000000001854","article-title":"Keystone Flaps: Physiology, Types, and Clinical Applications","volume":"83","author":"Riccio","year":"2019","journal-title":"Ann. Plast. Surg."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.bjps.2007.03.023","article-title":"The keystone design perforator island flap. Part II: Clinical applications","volume":"60","author":"Pelissier","year":"2007","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1055\/s-0044-1788990","article-title":"The Keystone Design Perforator Flap: A Flap to Simplify Complex Reconstructive Issues","volume":"57","author":"Bonetti","year":"2024","journal-title":"Indian J. Plast. Surg."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/SAP.0000000000004021","article-title":"The Vertical Profunda Artery Perforator Flap for Perineal Reconstruction","volume":"93","author":"Lavie","year":"2024","journal-title":"Ann. Plast. Surg."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"847","DOI":"10.12998\/wjcc.v9.i4.847","article-title":"Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse: A case report","volume":"9","author":"Yamamoto","year":"2021","journal-title":"World J. Clin. Cases"},{"key":"ref_88","first-page":"17455057231223716","article-title":"Maintaining vulvar, vaginal and perineal health: Clinical considerations","volume":"20","author":"Graziottin","year":"2024","journal-title":"Womens Health"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.urology.2003.08.001","article-title":"Childbirth-induced trauma to the urethral continence mechanism: Review and recommendations","volume":"62","author":"Baessler","year":"2003","journal-title":"Urology"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Raef, H.S., and Elmariah, S.B. (2021). Vulvar Pruritus: A Review of Clinical Associations, Pathophysiology and Therapeutic Management. Front. Med., 8.","DOI":"10.3389\/fmed.2021.649402"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/S0950-3552(89)80062-8","article-title":"Psychological aspects of gynaecological surgery","volume":"3","author":"Oates","year":"1989","journal-title":"Baillieres Clin. Obstet. Gynaecol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1136\/ijgc-00009577-200409000-00021","article-title":"Vulvar cancer patients\u2019 quality of life: A qualitative assessment","volume":"14","author":"Janda","year":"2004","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"56","DOI":"10.21500\/20112084.5981","article-title":"Clinical-Psychological Aspects Involved in Gynecological Surgery: Description of Peri-Operative Psychopathological Symptoms and Illness Behavior","volume":"16","author":"Mortilla","year":"2023","journal-title":"Int. J. Psychol. Res."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/aogs.14310","article-title":"Distress, problems and unmet rehabilitation needs after treatment for gynecological cancer","volume":"101","author":"Seland","year":"2022","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ejso.2014.10.050","article-title":"Quality of life and sexual function after surgery in early stage vulvar cancer","volume":"41","author":"Forner","year":"2015","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1007\/s10151-014-1156-6","article-title":"Vertical rectus abdominis myocutaneous flap and quality of life following abdominoperineal excision for rectal cancer: A multi-institutional study","volume":"18","author":"Burke","year":"2014","journal-title":"Tech. Coloproctol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.ygyno.2005.01.047","article-title":"The functional assessment of cancer-vulvar: Reliability and validity","volume":"97","author":"Janda","year":"2005","journal-title":"Gynecol. Oncol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4456\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:57:06Z","timestamp":1760032626000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4456"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":97,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134456"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134456","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,23]]}}}